Surgical impact on serum levels of insulin-like growth factor-1, insulin-like growth factor binding protein-3 and interleukin-6 in patients undergoing laparoscopic cholecystectomy: a comparative study versus open cholecystectomy

ABSTRACT

This study aimed at estimation of serum levels of insulin-like growth factor-1 [IGF-1], insulin-like growth factor binding protein-3 [IGFBP-3] and interleukin-6 [IL-6] in patients undergoing open [OC] or laparoscopic [LC] cholecystectomy so as to evaluate the impact of surgical procedure on their serum levels. The study comprised 30 patients [7 males and 23 females] assigned to undergo cholecystectomy for calcular cholecystitis. Laparoscopic cholecystectomy was performed according to the European "four-puncture" technique Blood samples were taken preoperatively and one [POD1] and 2 [POD2] days after surgery for determination of complete blood picture and estimation of serum IGF-1, IGFBP-3 and IL-6. The mean operative time was non-significantly prolonged in LC group, while, the mean wound length and duration of postoperative hospital stay were significantly [p<0.05] decreased in LC compared to OC group. Total leucocytic count [TLC] and the percentage of neutrophils showed progressive increase in both groups at POD1 and POD2 compared to preoperative counts; leucocytosis and neutrophilia were significant [p<0.05] at POD2 compared to levels estimated at POD1 in OC group but were non-significant in LC group and were significantly [p<0.05] higher in OC group compared to LC group at both POD1 and POD2. Serum IGF-1 was significantly [p<0.05] decreased in both groups at both POD1 and POD2 in comparison to preoperative levels, with a significant [p<0.05] increase at POD2 compared to levels estimated at POD1 in LC group, while the difference was non-significant [p>0.05] in OC group. Moreover, serum IGF-1 was significantly [p<0.05] higher in LC compared to OC group at both POD1 and POD2. Serum IGFBP-3 was decreased significantly [p<0.05] in OC group and non-significantly [p>0.05] in LC group in comparison to preoperative levels at both POD1 and POD2, with a significant [p<0.05] decrease in OC group compared to LC group at both PODI and POD2. Serum IGFBP-3 showed progressive decrease but with non-significant difference between its serum levels estimated at POD1 and POD2 in both groups. Serum IL-6 was increased significantly [p<0.05] in both groups in comparison to preoperative levels at both POD1 and POD2, with a significant [p<0.05] increase in OC compared to LC group at both POD1 and POD2. Serum IL-6 showed progressive increase but with non-significant difference between its serum levels estimated at POD1 and POD2 in both groups. There was a positive significant correlation between serum IL-6 and percentage of neutrophils at POD1 in both groups and a positive correlation with percentage of neutrophils at POD2 that was significant in OC group but was non-significant in LC group. Moreover, serum IL-6 levels showed a negative correlation with serum IGFBP-3 at both POD1 and POD2 that correlation was significant in OC and non-significant in LC group. It could be concluded surgery induces postoperative increased serum levels of IL-6 associated with decreased levels IGF-1 and IGFBP-3, such effect was minimized in patients underwent laparoscopic surgery and explain the shortened postoperative catabolic stage